Guidelines for radiology and nuclear medicine procedures taking call on nights and weekends: gastrointestinal bleeding, hepatobiliary and lung scans. It is interactive, e.g. using Keynote presentation software. PowerPoint
This document provides information on the diagnosis and management of acute pancreatitis. It discusses diagnostic criteria, physical exam findings, hematological and radiological investigations including CT severity index. It describes the different types of acute pancreatitis and outlines initial management involving aggressive hydration with Ringer's lactate and guidelines for use of ERCP and antibiotics.
This document provides an overview of acute pancreatitis. It begins by describing the pancreas and its functions. Acute pancreatitis is defined as reversible pancreatic injury associated with inflammation. It then discusses the epidemiology, pathogenesis, causes, symptoms, diagnosis, management, complications, and monitoring of acute pancreatitis. The presentation notes that acute pancreatitis is the most common gastrointestinal diagnosis for inpatients in the US. Causes include gallstones, alcohol use, hypertriglyceridemia, among others. Diagnosis involves abdominal pain, elevated pancreatic enzymes, and imaging findings. Management focuses on fluid resuscitation, pain control, preventing organ failure, and monitoring for complications like necrosis, fluid collections, and systemic effects.
1) Acute pancreatitis is an inflammation of the pancreas that can range from mild to severe. It involves autodigestion of the pancreas by its own enzymes.
2) There are two main types - edematous pancreatitis which is mild and necrotizing/hemorrhagic pancreatitis which is more severe and can lead to loss of pancreatic function.
3) Causes include gallstones, alcohol abuse, medications, trauma, hyperlipidemia and sometimes the cause is unknown. Clinical features include severe abdominal pain, nausea and tenderness on examination. Investigations include blood tests and imaging. Management involves IV fluids, nil by mouth, antibiotics if infected, and sometimes
Nuclear medicine in biliary tract disordersRamin Sadeghi
The document summarizes nuclear medicine techniques for evaluating various biliary tract disorders. Cholescintigraphy using radiotracers can help diagnose acute cholecystitis, functional gallbladder disorders, and gallstone ileus. It evaluates gallbladder ejection fraction to identify sphincter of Oddi dysfunction and determine surgical candidacy for patients with functional gallbladder disorders. Biliary leaks after surgery are also detectable on hepatobiliary scans.
This document discusses obstructive jaundice, including a case study of an 82-year-old male patient presenting with progressive jaundice, itching, weight loss, and other symptoms. It reviews the causes, pathophysiology, investigations, and management of obstructive jaundice. Common causes include gallstones, pancreatic cancer, and cholangiocarcinoma. Investigations may include blood tests, ultrasound, CT, MRCP, and ERCP. Management depends on the underlying cause but may involve surgical procedures like cholecystectomy, Whipple procedure, or stenting to relieve the obstruction.
1. The document summarizes guidelines for the management of acute pancreatitis, including diagnosis, etiology, risk stratification, initial management, role of ERCP, antibiotics, nutrition, and surgery.
2. Key points include diagnosing based on abdominal pain and elevated serum amylase/lipase, identifying gallstones and alcohol as common causes, and aggressively hydrating patients while considering nutrition via enteral feeding in severe cases.
3. Surgery is only recommended for gallstone pancreatitis patients without ongoing inflammation or fluid collections in order to prevent recurrence.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
This document provides information on the diagnosis and management of acute pancreatitis. It discusses diagnostic criteria, physical exam findings, hematological and radiological investigations including CT severity index. It describes the different types of acute pancreatitis and outlines initial management involving aggressive hydration with Ringer's lactate and guidelines for use of ERCP and antibiotics.
This document provides an overview of acute pancreatitis. It begins by describing the pancreas and its functions. Acute pancreatitis is defined as reversible pancreatic injury associated with inflammation. It then discusses the epidemiology, pathogenesis, causes, symptoms, diagnosis, management, complications, and monitoring of acute pancreatitis. The presentation notes that acute pancreatitis is the most common gastrointestinal diagnosis for inpatients in the US. Causes include gallstones, alcohol use, hypertriglyceridemia, among others. Diagnosis involves abdominal pain, elevated pancreatic enzymes, and imaging findings. Management focuses on fluid resuscitation, pain control, preventing organ failure, and monitoring for complications like necrosis, fluid collections, and systemic effects.
1) Acute pancreatitis is an inflammation of the pancreas that can range from mild to severe. It involves autodigestion of the pancreas by its own enzymes.
2) There are two main types - edematous pancreatitis which is mild and necrotizing/hemorrhagic pancreatitis which is more severe and can lead to loss of pancreatic function.
3) Causes include gallstones, alcohol abuse, medications, trauma, hyperlipidemia and sometimes the cause is unknown. Clinical features include severe abdominal pain, nausea and tenderness on examination. Investigations include blood tests and imaging. Management involves IV fluids, nil by mouth, antibiotics if infected, and sometimes
Nuclear medicine in biliary tract disordersRamin Sadeghi
The document summarizes nuclear medicine techniques for evaluating various biliary tract disorders. Cholescintigraphy using radiotracers can help diagnose acute cholecystitis, functional gallbladder disorders, and gallstone ileus. It evaluates gallbladder ejection fraction to identify sphincter of Oddi dysfunction and determine surgical candidacy for patients with functional gallbladder disorders. Biliary leaks after surgery are also detectable on hepatobiliary scans.
This document discusses obstructive jaundice, including a case study of an 82-year-old male patient presenting with progressive jaundice, itching, weight loss, and other symptoms. It reviews the causes, pathophysiology, investigations, and management of obstructive jaundice. Common causes include gallstones, pancreatic cancer, and cholangiocarcinoma. Investigations may include blood tests, ultrasound, CT, MRCP, and ERCP. Management depends on the underlying cause but may involve surgical procedures like cholecystectomy, Whipple procedure, or stenting to relieve the obstruction.
1. The document summarizes guidelines for the management of acute pancreatitis, including diagnosis, etiology, risk stratification, initial management, role of ERCP, antibiotics, nutrition, and surgery.
2. Key points include diagnosing based on abdominal pain and elevated serum amylase/lipase, identifying gallstones and alcohol as common causes, and aggressively hydrating patients while considering nutrition via enteral feeding in severe cases.
3. Surgery is only recommended for gallstone pancreatitis patients without ongoing inflammation or fluid collections in order to prevent recurrence.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
1. Acute pancreatitis is inflammation of the pancreas that presents with abdominal pain and elevated pancreatic enzymes. Gallstones and alcohol are the most common causes.
2. The pathogenesis involves premature activation of digestive enzymes within the pancreas due to obstruction of pancreatic ducts or direct injury to acinar cells. This leads to autodigestion of the pancreas.
3. Management involves hydration, pain control, treating complications, and considering surgery for gallstone pancreatitis to prevent recurrence.
The patient is a 65-year-old male with a history of chronic pancreatitis who presents with jaundice, weight loss, clay-colored stools, and itching. On examination, he appears jaundiced and emaciated with scratch marks and a palpable mass in the right upper abdomen. Imaging shows a mass in the head of the pancreas causing dilation of the pancreatic and bile ducts. Given the clinical findings and imaging results, pancreatic cancer is suspected. Biopsy of the mass confirms pancreatic adenocarcinoma. Surgical resection offers the only chance of cure but many patients have advanced disease at presentation.
Acute pancreatitis is defined as an acute inflammatory process of the pancreas that can involve other tissues. It is caused by premature activation of digestive enzymes within pancreatic cells leading to autodigestion. Acute pancreatitis is clinically defined by abdominal pain and elevated pancreatic enzymes. Gallstones and alcohol are common causes. Severity is classified based on organ failure and local complications. Treatment involves supportive care, pain management, intravenous fluids, nutritional support, and treating complications. New research focuses on modulating the immune response to reduce organ damage.
severe acute pancreatitis has high mortality rate and there is always confusions in between physicians. This topic is about management of acute pancreatitis its complications and ongoing controvercies. hope this will help and clear the doubts among physicians, residents and medical students
Obstructive jaundice is caused by obstruction of the bile ducts, preventing bile from reaching the duodenum. This document discusses the various causes of obstructive jaundice, including gallstones, pancreatic cancer, and cholangiocarcinoma. Diagnosis involves blood tests showing elevated bilirubin and imaging modalities like ultrasound, CT, MRCP and ERCP to identify the level and cause of obstruction. Treatment depends on the underlying cause but may include ERCP for gallstone removal, surgery like the Whipple procedure for pancreatic cancer, or stenting of inoperable tumors.
The document provides an overview of esophageal disorders, including their symptoms, diagnosis, and management. Key points include:
- Dysphagia can be caused by obstructive lesions like cancer/strictures or motility disorders. Diagnosis involves barium swallow, endoscopy, and manometry.
- Odynophagia can be due to conditions like GERD, infections, pill esophagitis, or radiation esophagitis.
- Barrett's esophagus develops in some with longstanding GERD and requires surveillance due to cancer risk.
- H. pylori testing is recommended if treating, for persistent dyspepsia, or lymphoma risk. Endoscopy is considered
Acute pancreatitis is inflammation of the pancreas that ranges from mild to severe. Mild cases involve pancreatic edema while severe cases involve pancreatic necrosis and multi-organ failure. The main causes are gallstones and alcohol use. Diagnosis is based on abdominal pain and elevated pancreatic enzymes. Severity is assessed using criteria like Ranson score, CT severity index, and Atlanta criteria. Treatment of mild cases involves fluids and pain control while severe cases require intensive care monitoring, fluids, nutrition, and may involve ERCP or surgery for complications.
Gastrocon 2016 - Dr S.K Sinha's observation on Acute PancreatitisApolloGleaneagls
The patient is a 40-year old male alcohol abuser presenting with abdominal pain, vomiting, and distension. Investigations show elevated lipase and CT scan shows bulky pancreas and gallbladder sludge. The patient meets criteria for acute pancreatitis and CT severity index of 8/10 suggests severe disease. While antibiotics are not routinely recommended, they may be considered for infected necrosis seen on imaging or clinical deterioration. Aggressive fluid resuscitation and pain management with tramadol are the primary treatments, with nutritional support and monitoring for organ dysfunction.
This document provides a case history, examination findings, investigations, and management plan for a 68-year-old male presenting with jaundice, abdominal pain, and itching for 20 days. Examination found jaundice, hepatomegaly, and abdominal tenderness. Liver function tests showed elevated bilirubin and alkaline phosphatase. Ultrasound and CT scan identified a mass in the periampullary region. The patient was diagnosed with obstructive jaundice likely due to a periampullary tumor and treated with antibiotics and pain medication.
This document summarizes key points about the management of acute pancreatitis. It discusses the epidemiology, etiology, clinical presentation, diagnostic evaluation, determination of severity, treatment approaches, and complications of acute pancreatitis. Management depends on determining if the pancreatitis is mild, moderate, or severe based on the presence of organ failure or local complications on imaging. Nutritional support, antibiotics, and drainage of fluid collections are addressed.
This document discusses acute pancreatitis, including its etiology, pathogenesis, clinical presentation, diagnosis, and management. The most common causes of acute pancreatitis are gallstones (30-60% of cases) and alcohol (15-30% of cases). The pathogenesis involves premature activation of pancreatic enzymes within the pancreas, leading to autodigestion and inflammation. Clinical features may include epigastric pain, nausea, vomiting, and signs of systemic inflammatory response. Diagnosis is based on abdominal pain consistent with acute pancreatitis and serum amylase or lipase levels over three times the upper limit of normal. Management involves fluid resuscitation, pain control, nothing by mouth initially, and antibiotics only for proven pancreatic necrosis.
This document provides an outline on acute pancreatitis covering its epidemiology, etiology, pathophysiology, clinical presentation, workup, severity scoring systems, treatment, and complications. It notes that acute pancreatitis is an inflammatory process where pancreatic enzymes auto-digest the gland. Worldwide incidence ranges from 5 to 80 per 100,000 people. Etiologies include alcohol, gallstones, hyperlipidemia, and trauma. Clinical presentation involves severe abdominal pain that radiates to the back. Workup includes blood tests and imaging like CT or ultrasound. Severity is assessed using scores like Ranson or Glasgow. Treatment focuses on supportive care, IV fluids, antibiotics, and ERCP for bile duct stones.
The document discusses acute pancreatitis, including causes, clinical features, diagnosis, severity grading, management, and prognosis. Gallstones and alcohol are the most common causes. Scoring systems like Ranson criteria and APACHE II can help indicate severity and prognosis. Management involves treatment of the underlying cause, supportive care, and monitoring for complications like pancreatic necrosis which may require intervention.
investigations and management of obstructive jaundice secondary to stone diseaseErum Khateeb
This document discusses the investigation and management of obstructive jaundice secondary to gallstone disease. It defines obstructive jaundice and describes the typical symptoms and signs. Common causes include gallstones, tumors, and strictures. Investigations include blood tests, ultrasound, CT, MRI/MRCP, ERCP and intraoperative cholangiography. Treatment involves correcting dehydration and coagulopathy conservatively or surgically removing gallstones via ERCP or open surgery. ERCP methods for extracting large or impacted stones include lithotripsy techniques.
This document discusses obstructive jaundice and neonatal hyperbilirubinemia. Neonates are more susceptible to hyperbilirubinemia due to physiological factors such as higher red blood cell count and liver immaturity. Biliary atresia is described as the atresia of the extrahepatic bile ducts in newborns caused by an unknown destructive inflammatory process. It is diagnosed using imaging and liver function tests and treated with surgery like Kasai portoenterostomy, though long term outcomes are generally poor without liver transplant.
This document summarizes chronic pancreatitis, including its definition, pathogenesis, clinical manifestations, diagnosis, and treatment options. It provides details on the histopathological changes in chronic pancreatitis, including fibrosis, reduced acinar cells and islets of Langerhans, duct dilation, and pancreatic stones. Medical management focuses on pain control and enzyme supplementation, while surgical options are considered for complications or intractable pain, and include pancreaticoduodenectomy, duodenum-preserving pancreatic head resection, and decompressive procedures.
This document provides an overview of acute pancreatitis, including its definitions, etiology, pathogenesis, and diagnostic assessment. It discusses the major causes of acute pancreatitis such as alcohol use, gallstones, medications, and genetic factors. The pathogenesis involves the abnormal activation of pancreatic enzymes leading to immune response and microcirculatory disturbances. Diagnosis is based on clinical features, elevated serum amylase and lipase levels, and imaging findings on ultrasound or CT scan. Several scoring systems are described to assess the severity of acute pancreatitis, including ATLANTA criteria, Ranson score, APACHE-II score, and Marshall score. Biochemical markers like CRP, PCT, and hematocrit can also help predict
Evaluation of the patient with benign Prostatic Hyperplasia(BPH)Labib Mortuza
This document provides an overview of how to evaluate a patient with benign prostatic hyperplasia (BPH). The evaluation involves taking a medical history, performing a physical exam including a digital rectal exam, and ordering relevant investigations. The medical history focuses on lower urinary tract symptoms and their severity is assessed using the International Prostate Symptom Score. The physical exam also includes neurologic tests to rule out other causes. Investigations include urine analysis, ultrasound of the kidneys/prostate/bladder, uroflowmetry, serum PSA, x-ray, and more. Based on the evaluation, BPH is staged and treatment is determined, which may include watchful waiting, medical therapy, or surgery.
1. Chronic pancreatitis represents a continuous inflammatory process of the pancreas resulting in permanent endocrine and exocrine dysfunction.
2. Chronic pancreatitis most commonly presents with abdominal pain in 95% of cases, along with weight loss, steatorrhea, and diabetes mellitus in some cases.
3. Diagnosis involves tests of pancreatic function like secretin stimulation tests and fecal elastase, as well as imaging with CT, MRI, and ERCP to detect features like pancreatic enlargement, calcifications, and ductal abnormalities.
Obstructive jaundice is one of the important surgical topics. In this playlist I have discussed the introduction, choledocholithiasis, Carcinoma Pancreas and biliary atresia. If you watch all these videos together you will become confident in Managing obstructive jaundice.
1. Acute pancreatitis is inflammation of the pancreas that presents with abdominal pain and elevated pancreatic enzymes. Gallstones and alcohol are the most common causes.
2. The pathogenesis involves premature activation of digestive enzymes within the pancreas due to obstruction of pancreatic ducts or direct injury to acinar cells. This leads to autodigestion of the pancreas.
3. Management involves hydration, pain control, treating complications, and considering surgery for gallstone pancreatitis to prevent recurrence.
The patient is a 65-year-old male with a history of chronic pancreatitis who presents with jaundice, weight loss, clay-colored stools, and itching. On examination, he appears jaundiced and emaciated with scratch marks and a palpable mass in the right upper abdomen. Imaging shows a mass in the head of the pancreas causing dilation of the pancreatic and bile ducts. Given the clinical findings and imaging results, pancreatic cancer is suspected. Biopsy of the mass confirms pancreatic adenocarcinoma. Surgical resection offers the only chance of cure but many patients have advanced disease at presentation.
Acute pancreatitis is defined as an acute inflammatory process of the pancreas that can involve other tissues. It is caused by premature activation of digestive enzymes within pancreatic cells leading to autodigestion. Acute pancreatitis is clinically defined by abdominal pain and elevated pancreatic enzymes. Gallstones and alcohol are common causes. Severity is classified based on organ failure and local complications. Treatment involves supportive care, pain management, intravenous fluids, nutritional support, and treating complications. New research focuses on modulating the immune response to reduce organ damage.
severe acute pancreatitis has high mortality rate and there is always confusions in between physicians. This topic is about management of acute pancreatitis its complications and ongoing controvercies. hope this will help and clear the doubts among physicians, residents and medical students
Obstructive jaundice is caused by obstruction of the bile ducts, preventing bile from reaching the duodenum. This document discusses the various causes of obstructive jaundice, including gallstones, pancreatic cancer, and cholangiocarcinoma. Diagnosis involves blood tests showing elevated bilirubin and imaging modalities like ultrasound, CT, MRCP and ERCP to identify the level and cause of obstruction. Treatment depends on the underlying cause but may include ERCP for gallstone removal, surgery like the Whipple procedure for pancreatic cancer, or stenting of inoperable tumors.
The document provides an overview of esophageal disorders, including their symptoms, diagnosis, and management. Key points include:
- Dysphagia can be caused by obstructive lesions like cancer/strictures or motility disorders. Diagnosis involves barium swallow, endoscopy, and manometry.
- Odynophagia can be due to conditions like GERD, infections, pill esophagitis, or radiation esophagitis.
- Barrett's esophagus develops in some with longstanding GERD and requires surveillance due to cancer risk.
- H. pylori testing is recommended if treating, for persistent dyspepsia, or lymphoma risk. Endoscopy is considered
Acute pancreatitis is inflammation of the pancreas that ranges from mild to severe. Mild cases involve pancreatic edema while severe cases involve pancreatic necrosis and multi-organ failure. The main causes are gallstones and alcohol use. Diagnosis is based on abdominal pain and elevated pancreatic enzymes. Severity is assessed using criteria like Ranson score, CT severity index, and Atlanta criteria. Treatment of mild cases involves fluids and pain control while severe cases require intensive care monitoring, fluids, nutrition, and may involve ERCP or surgery for complications.
Gastrocon 2016 - Dr S.K Sinha's observation on Acute PancreatitisApolloGleaneagls
The patient is a 40-year old male alcohol abuser presenting with abdominal pain, vomiting, and distension. Investigations show elevated lipase and CT scan shows bulky pancreas and gallbladder sludge. The patient meets criteria for acute pancreatitis and CT severity index of 8/10 suggests severe disease. While antibiotics are not routinely recommended, they may be considered for infected necrosis seen on imaging or clinical deterioration. Aggressive fluid resuscitation and pain management with tramadol are the primary treatments, with nutritional support and monitoring for organ dysfunction.
This document provides a case history, examination findings, investigations, and management plan for a 68-year-old male presenting with jaundice, abdominal pain, and itching for 20 days. Examination found jaundice, hepatomegaly, and abdominal tenderness. Liver function tests showed elevated bilirubin and alkaline phosphatase. Ultrasound and CT scan identified a mass in the periampullary region. The patient was diagnosed with obstructive jaundice likely due to a periampullary tumor and treated with antibiotics and pain medication.
This document summarizes key points about the management of acute pancreatitis. It discusses the epidemiology, etiology, clinical presentation, diagnostic evaluation, determination of severity, treatment approaches, and complications of acute pancreatitis. Management depends on determining if the pancreatitis is mild, moderate, or severe based on the presence of organ failure or local complications on imaging. Nutritional support, antibiotics, and drainage of fluid collections are addressed.
This document discusses acute pancreatitis, including its etiology, pathogenesis, clinical presentation, diagnosis, and management. The most common causes of acute pancreatitis are gallstones (30-60% of cases) and alcohol (15-30% of cases). The pathogenesis involves premature activation of pancreatic enzymes within the pancreas, leading to autodigestion and inflammation. Clinical features may include epigastric pain, nausea, vomiting, and signs of systemic inflammatory response. Diagnosis is based on abdominal pain consistent with acute pancreatitis and serum amylase or lipase levels over three times the upper limit of normal. Management involves fluid resuscitation, pain control, nothing by mouth initially, and antibiotics only for proven pancreatic necrosis.
This document provides an outline on acute pancreatitis covering its epidemiology, etiology, pathophysiology, clinical presentation, workup, severity scoring systems, treatment, and complications. It notes that acute pancreatitis is an inflammatory process where pancreatic enzymes auto-digest the gland. Worldwide incidence ranges from 5 to 80 per 100,000 people. Etiologies include alcohol, gallstones, hyperlipidemia, and trauma. Clinical presentation involves severe abdominal pain that radiates to the back. Workup includes blood tests and imaging like CT or ultrasound. Severity is assessed using scores like Ranson or Glasgow. Treatment focuses on supportive care, IV fluids, antibiotics, and ERCP for bile duct stones.
The document discusses acute pancreatitis, including causes, clinical features, diagnosis, severity grading, management, and prognosis. Gallstones and alcohol are the most common causes. Scoring systems like Ranson criteria and APACHE II can help indicate severity and prognosis. Management involves treatment of the underlying cause, supportive care, and monitoring for complications like pancreatic necrosis which may require intervention.
investigations and management of obstructive jaundice secondary to stone diseaseErum Khateeb
This document discusses the investigation and management of obstructive jaundice secondary to gallstone disease. It defines obstructive jaundice and describes the typical symptoms and signs. Common causes include gallstones, tumors, and strictures. Investigations include blood tests, ultrasound, CT, MRI/MRCP, ERCP and intraoperative cholangiography. Treatment involves correcting dehydration and coagulopathy conservatively or surgically removing gallstones via ERCP or open surgery. ERCP methods for extracting large or impacted stones include lithotripsy techniques.
This document discusses obstructive jaundice and neonatal hyperbilirubinemia. Neonates are more susceptible to hyperbilirubinemia due to physiological factors such as higher red blood cell count and liver immaturity. Biliary atresia is described as the atresia of the extrahepatic bile ducts in newborns caused by an unknown destructive inflammatory process. It is diagnosed using imaging and liver function tests and treated with surgery like Kasai portoenterostomy, though long term outcomes are generally poor without liver transplant.
This document summarizes chronic pancreatitis, including its definition, pathogenesis, clinical manifestations, diagnosis, and treatment options. It provides details on the histopathological changes in chronic pancreatitis, including fibrosis, reduced acinar cells and islets of Langerhans, duct dilation, and pancreatic stones. Medical management focuses on pain control and enzyme supplementation, while surgical options are considered for complications or intractable pain, and include pancreaticoduodenectomy, duodenum-preserving pancreatic head resection, and decompressive procedures.
This document provides an overview of acute pancreatitis, including its definitions, etiology, pathogenesis, and diagnostic assessment. It discusses the major causes of acute pancreatitis such as alcohol use, gallstones, medications, and genetic factors. The pathogenesis involves the abnormal activation of pancreatic enzymes leading to immune response and microcirculatory disturbances. Diagnosis is based on clinical features, elevated serum amylase and lipase levels, and imaging findings on ultrasound or CT scan. Several scoring systems are described to assess the severity of acute pancreatitis, including ATLANTA criteria, Ranson score, APACHE-II score, and Marshall score. Biochemical markers like CRP, PCT, and hematocrit can also help predict
Evaluation of the patient with benign Prostatic Hyperplasia(BPH)Labib Mortuza
This document provides an overview of how to evaluate a patient with benign prostatic hyperplasia (BPH). The evaluation involves taking a medical history, performing a physical exam including a digital rectal exam, and ordering relevant investigations. The medical history focuses on lower urinary tract symptoms and their severity is assessed using the International Prostate Symptom Score. The physical exam also includes neurologic tests to rule out other causes. Investigations include urine analysis, ultrasound of the kidneys/prostate/bladder, uroflowmetry, serum PSA, x-ray, and more. Based on the evaluation, BPH is staged and treatment is determined, which may include watchful waiting, medical therapy, or surgery.
1. Chronic pancreatitis represents a continuous inflammatory process of the pancreas resulting in permanent endocrine and exocrine dysfunction.
2. Chronic pancreatitis most commonly presents with abdominal pain in 95% of cases, along with weight loss, steatorrhea, and diabetes mellitus in some cases.
3. Diagnosis involves tests of pancreatic function like secretin stimulation tests and fecal elastase, as well as imaging with CT, MRI, and ERCP to detect features like pancreatic enlargement, calcifications, and ductal abnormalities.
Obstructive jaundice is one of the important surgical topics. In this playlist I have discussed the introduction, choledocholithiasis, Carcinoma Pancreas and biliary atresia. If you watch all these videos together you will become confident in Managing obstructive jaundice.
George, a 40-year-old male with a history of chronic alcoholism and gallstones, presented with severe abdominal pain after starting sulfasalazine for ulcerative colitis. Lab results showed elevated amylase, lipase, and white blood cell count. The physician's diagnosis was acute pancreatitis, likely caused by sulfasalazine triggering the condition. Due to the severity of symptoms and lab abnormalities, the patient should be admitted to the ICU and given IV fluids, analgesics, and monitored closely for complications of acute pancreatitis.
Acute liver failure is characterized by initial non-specific symptoms that progress to hepatic encephalopathy. It is defined as evidence of coagulopathy and mental alteration occurring within 26 weeks in a patient without pre-existing liver disease. Initial management involves fluid/electrolyte maintenance, nutrition, treatment of the underlying cause, and consideration of liver transplantation if criteria are met. ICU admission is warranted for altered sensorium, respiratory distress, bleeding, or hemodynamic instability. The prognosis depends on the severity and etiology of the liver injury.
This document discusses functional hepatobiliary diseases, including chronic acalculous cholecystitis, gallbladder ejection fraction testing, and sphincter of Oddi dysfunction. It provides details on protocols for gallbladder ejection fraction testing using cholecystokinin cholescintigraphy or fatty meal stimulation. An abnormal ejection fraction below 35% may indicate gallbladder dyskinesia. Sphincter of Oddi dysfunction can cause post-cholecystectomy pain and be diagnosed using cholescintigraphy by detecting delayed biliary clearance after CCK administration. Therapies may include sphincterotomy or drugs to relax the sphincter of Oddi.
This document provides an overview of acute pancreatitis including its:
- Pathophysiology involving trypsin activation within acinar cells
- Risk factors such as gallstones, alcohol use, anatomical obstructions
- Clinical manifestations like severe abdominal pain
- Diagnosis using blood tests, imaging, and scoring systems to determine severity
- Management approaches depending on severity, including antibiotics for infected necrosis
This document provides information on acute pancreatitis including:
- The anatomy and blood supply of the pancreas.
- Risk factors, pathophysiology, clinical presentation, diagnosis and management of acute pancreatitis including determining severity.
- Choice of antibiotics and analgesics for severe acute pancreatitis, with imipenem and ciprofloxacin/metronidazole recommended for infected pancreatic necrosis.
- Novel pain management strategies like thoracic epidural analgesia and inhibitors of proteinase-activated receptors and transient receptor potential vanilloid-1 showing promise in animal models of acute pancreatitis.
This document discusses acute pancreatitis. It begins with a case presentation of a 30-year-old patient presenting with epigastric pain. It then provides general information on the pancreas and its secretions of bicarbonate and enzymes. It describes the signs, symptoms, lab tests, imaging studies, differential diagnosis, phases, severity, treatment, and recurrence risks of acute pancreatitis. Treatment involves NPO, IV fluids, analgesics, and treating any underlying causes like gallstones.
This document summarizes benign prostatic hyperplasia (BPH). It finds that the incidence of BPH increases with age, affecting 20% of men aged 41-50 and over 90% of men over 80. Risk factors include genetics and race. BPH causes both obstructive symptoms like weak urinary stream and irritative symptoms like frequent urination. Treatment options range from watchful waiting for mild cases to drug therapies like alpha blockers and 5-alpha reductase inhibitors to surgical procedures like transurethral resection of the prostate. Minimally invasive procedures also exist like laser therapy, transurethral vaporization of the prostate, and transurethral needle ablation of the prostate.
This document presents the case of a 14-year-old female patient admitted with recurrent acute pancreatitis. Her episodes are associated with hypertriglyceridemia. Her brother also had a history of similar symptoms. Laboratory tests revealed elevated triglyceride levels in the patient and her family members. She was diagnosed with familial hypertriglyceridemia-induced recurrent acute pancreatitis. Treatment involved managing triglyceride levels and supportive care for the acute attack.
This document provides information about jaundice and obstruction of the biliary tract. It begins with an overview of the causes of yellow discoloration of the skin and mucous membranes, which is caused by bilirubin accumulation. It then describes the breakdown of red blood cells and how bilirubin is processed and excreted. The document outlines various causes of obstructive jaundice including gallstones, strictures, tumors, and external compression. Investigation methods and treatment approaches for different biliary obstructions are also summarized.
This document provides guidance on approaching a patient presenting with jaundice. It defines jaundice and distinguishes it from carotenemia. The document outlines the causes of jaundice as pre-hepatic, hepatic, or post-hepatic. It recommends taking a thorough history, performing a physical exam, and ordering lab tests and imaging to determine the underlying cause and guide management, which may include stopping hepatotoxic drugs, medical treatment, or surgery.
This document contains the questions and answers from a quiz on gastrointestinal surgery. It addresses topics like T-tube cholangiograms following cholecystectomy, investigations and treatments for common bile duct stones, ERCP findings for cholangiocarcinoma, radiological features and management of Crohn's disease, ulcerative colitis, and linitis plastica of the stomach. The questions assess knowledge of appropriate investigations, diagnoses, complications, and treatment options for various gastrointestinal conditions.
Liver and kidney diseases can complicate pregnancy. Unique liver diseases include intrahepatic cholestasis of pregnancy (ICP), acute fatty liver of pregnancy (AFLP), and HELLP syndrome. ICP causes pruritus and jaundice. AFLP results in fatty infiltration of hepatocytes. Kidney diseases increase risks of preeclampsia, preterm birth, and infection. Acute pyelonephritis is common. Chronic kidney disease poses high risks. Pregnancy while receiving dialysis or after transplant requires monitoring due to hypertension and infection risks.
This document provides an overview of benign prostatic hyperplasia (BPH), including its anatomy, epidemiology, pathophysiology, clinical features, diagnosis, investigations, and treatment options. It discusses the relevant anatomy of the prostate and zones of the prostate involved in BPH. It also outlines guidelines for diagnosis, potential investigations including prostate-specific antigen testing, and treatment modalities including watchful waiting, medical therapy, minimally invasive procedures, and surgical options like transurethral resection of the prostate. Complications of treatments are also summarized.
Acute pancreatitis is an inflammatory process of the pancreas that can involve surrounding tissues or remote organ systems. The most common causes are gallstones and alcohol. The pathogenesis involves premature activation of digestive enzymes within the pancreas that cause autodigestion. Clinical presentation includes severe upper abdominal pain and elevated pancreatic enzymes. Diagnosis requires abdominal pain consistent with pancreatitis plus elevated pancreatic enzymes or radiologic findings. Complications can include pancreatic necrosis, pseudocyst formation, and systemic inflammatory response.
This document provides an overview of benign and malignant prostate diseases, including BPH, prostate cancer, and prostatitis. It discusses the anatomy, epidemiology, etiology, pathogenesis, clinical findings, diagnosis and treatment options for each condition. For BPH, it describes the incidence, risk factors, symptoms, signs, evaluation, medical therapies including alpha blockers and 5-alpha reductase inhibitors, and surgical treatments such as TURP, TUIP and stents. For prostate cancer, it covers grading, staging, pattern of progression, tumor markers like PSA, biopsy for diagnosis, and imaging with ultrasound and CT.
Dr. Saba Khan presents a case of an 80-year-old male who presented with lower urinary tract symptoms including frequency, urgency, hesitancy, and poor urine flow. Investigations found benign prostate hyperplasia. The patient underwent a transurethral resection of the prostate but developed urine retention post-operatively which required bladder washouts. The patient was discharged after 13 days with an indwelling catheter but later readmitted briefly for observation before being discharged again with oral medications.
This document provides an overview of evaluating patients with benign prostatic hyperplasia (BPH). It discusses taking a history, performing a physical exam including a digital rectal exam and neurological exam, and relevant investigations like the International Prostate Symptom Score, urinalysis, ultrasound, uroflowmetry, and serum PSA. Treatment options for BPH include watchful waiting, medical therapy with alpha blockers or 5-alpha reductase inhibitors, and surgical options like transurethral resection of the prostate or open prostatectomy. The goal of treatment is to relieve symptoms and obstruction based on the patient's severity and risk factors.
This document describes a case of obstructive jaundice in an 82-year-old male presenting with progressive jaundice, itching, weight loss, and pale stools. Examination found jaundice, scratch marks, and a palpable gallbladder. Investigations showed elevated bilirubin and alkaline phosphatase consistent with obstructive jaundice. Imaging found a solid mass in the distal common bile duct. The causes, pathophysiology, investigations, and management of obstructive jaundice are then reviewed, focusing on endoscopic or surgical interventions depending on the underlying cause such as gallstones, pancreatic cancer, cholangiocarcinoma. Prognosis depends on factors like type of obstruction and patient
Similar to Call prep: emergency nuclear medicine procedures (20)
Fear of stunning: I-123 vs 131 for whole body imaging in thyroid cancerHerbert Klein
Whole body imaging is used to detect metastatic differentiated thyroid cancer. It can be done with I-123 or I-131. The points for one or the other are discussed in this PowerPoint presentation, with special attention to the possibility that a scan using I-131 might decrease the impact of subsequent therapeutic doses of I-131, by a so-called stunning effect on the iodine-avid lesions. Clinical examples are presented.
Radionuclide therapy of bone metastases and non-Hodgkin’s lymphoma (radioimmu...Herbert Klein
Both ibritumomab and tositumomab are murine monoclonal antibodies that target the CD20 antigen on B-cells. Ibritumomab is radiolabeled with yttrium-90 for radioimmunotherapy of non-Hodgkin's lymphoma, while tositumomab is radiolabeled with iodine-131. The document discusses the properties and mechanisms of various radiopharmaceuticals used in the treatment of bone metastases and radioimmunotherapy of lymphoma, including their emission types, dose formulas, side effects, and factors to consider before administration.
Radioiodine ablation of normal remnants after less-than-total thyroidectomy f...Herbert Klein
After less-than-total thyroidectomy for thyroid cancer, I-131 is commonly used to ablate the remnant, as distinct from treatment of metastases. This PowerPoint discusses the rationale for ablation and the evidence in the medical literature regarding this, with clinical examples.
This document outlines an algorithmic diagnostic approach for patients presenting with recurrent hyperthyroidism. It involves testing sensitive TSH levels and performing radioactive iodine uptake scans to differentiate between possible causes such as Graves' disease, toxic multinodular goiter, or solitary autonomous nodules. The document also notes some terminology distinctions for various thyroid conditions and imaging techniques.
The role of nuclear medicine in differentiated thyroid cancer (DTC)Herbert Klein
PowerPoint: Guidelines for the management of differentiated thyroid cancer are discussed with special reference to the use of radioiodine imaging and therapy.
PowerPoint. Nonradioactive iodine competes with radioactive iodine. This has implications for the use of recombinant human TSH (rhTSH) when preparing differentiated thyroid cancer patients for radioiodine scanning with continued levothyroxine, because the latter contains iodine.
This document provides an outline and overview of a presentation on radiation and its risks and benefits. It begins with definitions of electromagnetic radiation and ionizing radiation. It then discusses the history of radiation discovery and uses. This includes pioneers like Roentgen and Curie and studies of radiation effects on survivors of the atomic bombs in Japan. The document focuses on the debate around risks of low-dose radiation from medical scans like CT scans. It discusses the limitations of observational studies and strengths of randomized controlled trials. It also reviews theories around radiation risk at low doses and compares risks to activities like smoking.
Medical imaging meets psychology of perception: optical illusions!Herbert Klein
PowerPoint about an optical illusion and psychology of perception as applied to medical imaging. It is interactive (as with Keynote). A rotating 3D image of a nuclear medicine bone scan is the key clinical example.
1976 essay about Roosevelt Island, once Welfare Island, in the East River of NYC It was then home of several hospitals, including a Columbia University Medical School affiliation. It has since become accessible by aerial tramway.
Controversial Responses to Opioid AddictionHerbert Klein
PowerPoint. Controversial responses to opioid addiction. An essay on multiple aspects of the issue: 1. medication-assisted treatment (MAT), 2. the criminal justice system, 3. harm reduction and 4. marijuana. See also an updated essay called "opioids".
Can Traditional Chinese Medicine Treat Blocked Fallopian Tubes.pptxFFragrant
There are many traditional Chinese medicine therapies to treat blocked fallopian tubes. And herbal medicine Fuyan Pill is one of the more effective choices.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
Home
Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
Applications of NMR in Protein Structure Prediction.pptxAnagha R Anil
This presentation explores the pivotal role of Nuclear Magnetic Resonance (NMR) spectroscopy in predicting protein structures. It delves into the methodologies, advancements, and applications of NMR in determining the three-dimensional configurations of proteins, which is crucial for understanding their function and interactions.
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)MuskanShingari
Skin is the largest organ of the human body, serving crucial functions that include protection, sensation, regulation, and synthesis. Structurally, it consists of three main layers: the epidermis, dermis, and hypodermis (subcutaneous layer).
1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
Skin performs essential functions such as regulating body temperature through sweat production and blood flow control, synthesizing vitamin D when exposed to sunlight, and serving as a sensory interface with the external environment.
Maintaining skin health is crucial for overall well-being, involving proper hygiene, hydration, protection from sun exposure, and avoiding harmful substances. Skin conditions and diseases range from minor irritations to chronic disorders, emphasizing the importance of regular care and medical attention when needed.
Receptor Discordance in Breast Carcinoma During the Course of Life
Definition:
Receptor discordance refers to changes in the status of hormone receptors (estrogen receptor ERα, progesterone receptor PgR, and HER2) in breast cancer tumors over time or between primary and metastatic sites.
Causes:
Tumor Evolution:
Genetic and epigenetic changes during tumor progression can lead to alterations in receptor status.
Treatment Effects:
Therapies, especially endocrine and targeted therapies, can selectively pressure tumor cells, causing shifts in receptor expression.
Heterogeneity:
Inherent heterogeneity within the tumor can result in subpopulations of cells with different receptor statuses.
Impact on Treatment:
Therapeutic Resistance:
Loss of ERα or PgR can lead to resistance to endocrine therapies.
HER2 discordance affects the efficacy of HER2-targeted treatments.
Treatment Adjustment:
Regular reassessment of receptor status may be necessary to adjust treatment strategies appropriately.
Clinical Implications:
Prognosis:
Receptor discordance is often associated with a poorer prognosis.
Biopsies:
Obtaining biopsies from metastatic sites is crucial for accurate receptor status assessment and effective treatment planning.
Monitoring:
Continuous monitoring of receptor status throughout the disease course can guide personalized therapy adjustments.
Understanding and managing receptor discordance is essential for optimizing treatment outcomes and improving the prognosis for breast cancer patients.
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
3. 80 y.o. woman with profuse rectal
bleeding.
What is the diagnosis?
1. Normal
2. Technical problem
3. Large bowel bleed
4. Small bowel bleed
5. None of the above
0%
20%
40% 40%
0%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
4. Large bowel bleed, likely splenic
flexure, with some retrograde motion.
Blood stimulates peristalsis.
5. Large bowel bleed, likely splenic flexure, with some
retrograde motion. Blood stimulates peristalsis.
6. •Indication: GI bleed.
•Radiopharmaceutical: Tc-99m labeled
autologous red blood cells, 30 mCi. (In
vitro method for best tagging.)
•Image anterior abdomen:
•Flow: 1 sec/frame for 60 sec
•Function: 60 sec/frame for 60 min.
•Additional imaging may be needed.
7. More sensitive than angiography. Rates of
the order of 0.2 -0.3 mL/min or less are
detected (angiography--~1 mL/min).
Problem is that bleeding is intermittent.
The main purpose is to identify the site.
This can aid in decisions re selective
angiography and surgical intervention.
Most bleeding sites show a focus that
increases and changes position and/or
configuration with time.
Sites seen in delayed imaging are uncertain
as to origin.
Normal findings may include bladder urine
and male genitalia.
9. 67-y.o. male with tarry stool and
decreasing hematocrit.
What is the diagnosis?
1. Normal
2. Technical problem
3. Large bowel bleed
4. Small bowel bleed
5. None of the above
44%
11% 11%
22%
11%
0%
10%
20%
30%
40%
50%
10. Normal. There can be variation in ap-
pearance of vascular compartment
13. 62-.o. male with bright red blood
per rectum
What is the diagnosis?
1. Normal
2. Technical problem
3. Large bowel bleed
4. Small bowel bleed
5. None of the above
12%
38%
25%
0%
25%
0%
5%
10%
15%
20%
25%
30%
35%
40%
14. This is more likely a technical problem than a
gastric bleed, because of bright red blood.
(Could be checked with gastroscopy.)
Specifically, it is likely due to a poor tag and
free pertechnetate, which is taken up by the
stomach. A very inadequate tag may lead to a
false negative. Typically, pertechnetate is
taken up by thyroid and salivary glands, but
beware of absent or nonfunctioning thyroid.
17. RUQ pain
What should we do now?
1. Report normal study
2. Report acute
cholecystitis
3. Report other
abnormality
4. Administer sincalide
5. Administer
morphine
43%
14%
0% 0%
43%
0%
10%
20%
30%
40%
50%
18. When the GB is not visualized
during 1 hour of imaging,
morphine, 0.04 mg/kg (max 5
mg) may be administered to
tighten the sphincter of Oddi
and make the cystic duct the
path of least resistance. Image 0.5
h.
19. Morphine may be inadvisable or
contraindicated with hyperamylasemia (or
pancreatitis), narcotic addiction, history of
adverse reaction to morphine, respiratory
depression, increased intracranial pressure in
children, or if there is no bowel activity seen.
21. Post-morphine images
What is the diagnosis?
1. Normal study
2. Acute cholecystitis
3. Chronic gallbladder
disease
4. Bile leak
5. Other abnormality
44%
11%
33%
11%
0%
0%
10%
20%
30%
40%
50%
23. Indication: Usually suspicion of acute
cholecystitis.
Radiopharmaceutical: Tc-99m mebrofenin
(Choletec) IV, 5 mCi (10 with
hyperbilirubinemia). It is excreted in bile,
somewhat like bilirubin.
Patient should be NPO 4-24 h, preferably no
opiods 4 h.
Flow 1 sec/frame for 60 frames
Function: 60 sec/frame for 60 min; 90 min if
for suspected biliary leak
24. Sincalide =Kinevac= CCK-8.
Physiologically active C-terminal octapeptide
of the polypeptide hormone cholecystokinin
(CCK). It produces gallbladder contraction and
sphincter of Oddi relaxation.
Often called CCK, as in “Please do a HIDA
scan with CCK.”
25. Two basic uses of sincalide
1. To avoid false positives
(nonvisualization of GB), “prime”
with 0.02 µg/kg in 50 ml normal
saline over 20 min, if patient has
been NPO > 24 h or on TPN,
conditions that cause GB distension
with viscous bile, and begin the
study 30 min later (time for GB to
relax).
26. Sincalide, continued
2. For the evaluation of upper
abdominal pain thought to be
biliary in origin, with
ultrasonographically normal
appearing gallbladder. After initial
imaging reveals GB visualization,
give 0.02 mcg/kg in normal saline
over 60 min. Image 60 sec/frame
during the full time of infusion.
27. False positives may occur in hospitalized or
acutely ill patients because of their acute illness
and/or medications like morphine and other
opiates , benzodiazepenes, ethanol, octreotide,
nicotine, nifedipine, pirenzepine, progesterone,
theophylline (partial list).
28. Normal hepatobiliary scan
Rapid uptake into the hepatic
parenchyma, rapid clearance of the
cardiac blood pool, followed by activity
in ductal system, GB and small bowel, all
within 1 h.
Acute cholecystitis is diagnosed when
there is nonvisualization to 4 h or 30 min
after morphine. The hallmark of acute
cholecystitis is cystic duct obstruction,
hence nonvisualization of the GB.
32. GBEF
Usually ordered as such, nonemergently.
May be appended to a normal inpatient
study (with provider’s authorization) for
chronic suspicious symptoms. Caution
recommended.
“[The report of a positive result]
generally should conclude with a
statement…such as ‘In the appropriate
clinical setting, this is consistent with
functional gallbladder disorder’
33. What is the condition we are
diagnosing? Various terms have
been used: gallbladder dyskinesia,
chronic acalculous gallbladder
dysfunction, acalculous biliary
disease, chronic acalculous
cholecystitis or biliary dyskinesia. To
prevent confusion, the authors have
proposed the term “functional
gallbladder disorder.”
36. Rim sign: A rim of activity above the GB fossa
indicating a high probability of acute cholecystitis with
complications like perforated or gangrenous GB. Likely
surgical emergency.
37.
38. Bile leak, biloma. In leaks,
activity may be free in abdomen,
e.g. paracolic gutters or
outlining bowel loops.
41. 52-year-old female with a history of
rising bilirubin
What is the diagnosis?
1. Normal study
2. Acute cholecystitis
3. Chronic gallbladder
disease
4. Bile leak
5. Other abnormality
12%
0%
12%
0%
75%
0%
10%
20%
30%
40%
50%
60%
70%
80%
42. Other abnormality
Impaired liver function with poor clearance
of cardiac blood pool.
Delayed visualization of GB rules out acute
cholecystitis, but does not demonstrate
chronic cholecystitis. Delayed imaging is
needed in such cases.
Transit to bowel is also seen, but not quickly.
44. It is preferable to wait 4-6 hours after opiates
like morphine before a biliary scan.
Sincalide after morphine may give false
positive EF.
Morphine is OK after sincalide (short half-life).
Contraindications to sincalide are known
allergic reaction, intestinal obstruction and
pregnancy.
47. Suspect P.E.
We should report:
1. High probability of
P.E.
2. Low probability of
P.E.
3. Intermediate
probability of P.E.
4. Technical problem
5. None of the above
0%
62%
12%
0%
25%
0%
10%
20%
30%
40%
50%
60%
70%
48. None of the above.
The study is normal, implying negligible
probability of P.E., regardless of
ventilation or chest x-ray.
Note: Standard 8 views, A-P gradient
on perfusion (as in normal subjects
injected supine). Effect is less in
ventilation. Note some tracheal and
stomach activity crossing over to
perfusion scan.
50. Local protocol
Indication: Usually suspicion of PE.
Radiopharmaceuticals:
40.0 mCi Tc-99m DTPA by aeorosol, 0.5-2 µm
droplets, patient supine or upright
5.0 mCi Tc-99m MAA IV (~30 µm,vs 7-10µm of
capillaries , patient supine
PA and lateral chest x-ray within 24 h (more current
if clinical picture is changing)
Ventilation 200 kcts A, P, RAO, LPO, RL, LL,
RPO, LAO
Then, perfusion 800 kcts, same views.
51. Summary/generalizations re diagnosis of PE
The count rate of the perfusion study should be
3-4 times that of the ventilation study. Confirm
from total counts and time.
A normal perfusion scan essentially excludes
clinically relevant PE.
Typically, PE causes bilateral, multiple wedge-
shaped defects that extend to the periphery
that are unmatched (mismatched) with
ventilation.
Other causes of perfusion defects are COPD,
pneumonia, asthma, tumor, etc., but they are
typically matched with ventilation. Reflex
vasoconstriction occurs secondary to hypoxia.
Reverse mismatch does not indicate PE.
54. UPMC consensus criteria: Mettler interpretation of
PIOPED data (Mettler and Guiberteau Table 7-5)
Normal: No perfusion defects: neglible chance
of PE
Very low probability (<10% chance)
1. 3 or fewer small (<25% segment) defects, neg.
CXR.
2. Non-segmental defects (large aortic knob, high
diaphragm).
3. Triple match in upper to mid lung zone.
4. Perfusion defect considerably smaller than CXR
opacity.
5. Stripe sign (on all views).
55. Criteria (cont.)
Low probability (10% to less than 20%
chance)
1. Multiple matched defects with negative CXR.
2. More than 3 small (<25% segment) defects, neg.
CXR
3. Large matching effusion.
Intermediate probability (20-80% chance)
Triple match lower lung zone (opacity or small
pleural effusion)
Single moderate segmental match, neg. CXR
Single mismatch, moderate to large, two moderate or
one large/one moderate
56. Criteria, concluded
High probability (greater than 80%)
1. At least two large, or one large and two moderate,
or four moderate mismatches
2. Large perfusion defect, considerably larger than
CXR abnormality
57. Probabilities of P.E. are best modified by
pretest probability.
The current SNM guidelines have 4
alternative interpretation schemes, and they
substitute the term likelihood ratio (LR),
which is independent of pre-test
probability. LR x pre-test probability = post-
test probability.
58.
59.
60.
61. 71-y.o. male with dyspnea
We should report:
1. Normal
2. Very low
probability
3. Low probability
4. Intermediate
probability
5. High probability
0% 0%
100%
0% 0%
0%
20%
40%
60%
80%
100%
120%
67. 58-y.o. female with dyspnea & right-
sided chest pain
We should report
1. Normal
2. Very low
probability
3. Low probability
4. Intermediate
probability
5. High probability
0% 0% 0% 0% 0%
0%
20%
40%
60%
80%
100%
I’m going to start each section with a case, then go back to the basics of the procedure. Next, show Menis, #11, 16096
Questions will be the same for all in this series.
Show Feerst, #8,16101
Note transit to small bowel.
Questions will be the same for all in this series.
Vs. acute, if not visualized.
Show Bernard, Mark. 27-yo M c abdominal pain. Separate CD. 1st movie (2nd). Then post sinc movie. (1st)
Ismaeli, just statics. (Normal GBEF.) .) When would you do (or not do) the EF? How do you give the sincalide? What is sincalide? Can you give it a second time? NOTE, this is old 30 min protocol.
Not obligatory with an emergency negative study.
Gilbert, Michelle. Note breast shadow, not a rim sign.
Show Troy, Thomas, #5, 16108, no Hx
Important distinction, as we shall see.
Hi prob static. Low ratio a problem because of cross-talk, can occur because of equipment, technique, patient’s breathing pattern.
Note that you can barely see the medial basal segment of the RLL (#7, row 3, R),
(after quiz:)) Note: The count ratio is adequate. Still there is obvious cross-talk from large airways deposition and likely some related to the defects. Defects are less pronounced on perfusion: this would mitigate toward lower probability. The chest x-ray showed some congestion, but no distinct defects.
Go back to slide 63. Then show Willis, Bonnie, indeterminate. 58-yo F dyspnea and R-sided chest pain.
NOTE: could be very low prob. Because ventilation defects are worse.
(after quiz:)) Note: The count ratio is adequate. Still there is obvious cross-talk from large airways deposition and likely some related to the defects. Defects are less pronounced on perfusion: this would mitigate toward lower probability. The chest x-ray showed some congestion, but no distinct defects.
Note very good count ratio of 7, calculable from numbers on the posterior. Still some problem from large airways deposition, though.